Alabama just became the latest bright spot in efforts to defend abortion rights against consistent attacks at the state level. On Monday, federal judge declared unconstitutional a 2013 law requiring that abortion providers obtain admitting privileges at area hospitals.
Proponents of the law had argued that it was intended to keep women safe, and that without the requirement, providers can't ensure that a patient will be moved quickly to the hospital when the need arises. But the judge disagreed, echoing the American Congress of Obstetricians and Gynecologists' and the American Medical Association's arguments against the alleged medical basis for such laws. Complications requiring hospitalization occur in just .05 to .3 percent of early-term abortions, the type performed at the Alabama clinics in question. With the safety argument exposed as empty, the judge found that the law serves no purpose other than to outlaw abortion in huge swaths of the state.
According to the decision: "…If this requirement would not, in the face of all the evidence in the record, constitute an impermissible undue burden, then almost no regulation, short of those imposing an outright prohibition on abortion, would." In other words: If this isn't a sneaky way to ban the procedure, I don't know what is.
Had it gone into effect, the law would have put access to abortion out of reach for many Alabama women, particularly those in the southern part of the state. Clinics in Birmingham, Mobile and Montgomery — Alabama's three most populous cities — would have been forced to close. In 2012, these clinics performed 40 percent of all legal abortions in the state. According to the decision, it would have been unlikely that providers there could have gotten staff privileges, either because they don't live within a specific radius of the local hospital, the early-term abortions they provide are too safe to necessitate that they admit a patient for additional care (after all, you have to use the privilege in order to get and maintain it), or because the granting of such privileges is subjective, often made at the whims of hospital administrators.
The ruling comes on the heels of a federal court's decision last week to continue to block a similar law in Mississippi. If that state's admitting privileges law is eventually allowed to go into effect, Mississippi's last abortion clinic will close.
"These laws have little to do with women's health, and they're 100 percent about politics," Alexa Kolbi-Molinas, ACLU's lead counsel on the Alabama case, told me. The ACLU argued the case along with Planned Parenthood.
Judge Myron Thompson appears to agree. His entire decision is worth a read, in part because it paints such a vivid picture of the political climate surrounding abortion in the state and the region. It recounts a history of violence against providers and clinics, including murders and firebombings throughout the last two decades. It details the high consequences doctors there face when their practices include providing abortions (one reason providers fly into Alabama from their homes elsewhere), and the lack of training available for medical students in the South. According to the decision: "…Only 8 percent of OB/GYNs in the South perform any abortions at all, compared to 26 percent in the Northeast. In Louisiana, Alabama and Mississippi, no residency program offers abortion training to OB/GYN medical residents." Clearly, access to abortion is already a challenge for families in the state. In 2001 a dozen clinics provided the procedure in Alabama. Today, there are only five.
Poor women pay the price. At the three clinics that would have closed, more than half of abortion patients live at or below 150 percent of the poverty line, according to the decision. Simply traveling elsewhere for the procedure isn't so easy when transportation and lost wages make the endeavor just too expensive.
On a conference call for media earlier this summer, ACLU Reproductive Freedom Project Director Jennifer Dalven pointed out that admitting privileges as a backdoor ban on abortion is especially worth watching in the South, where a contiguous five state block faced such laws. In addition to Alabama and Mississippi, similar requirements passed in Oklahoma and Louisiana earlier this year. A review of the Texas law is pending. Further north in Wisconsin, attorneys with the ACLU and Planned Parenthood have challenged an admitting privileges law and a ruling in that case is expected soon. The Alabama decision sends a critical message, according to Kolbi-Molinas.
"It should be instructive to future courts as they look at these issues," she said. "And hopefully [instructive] to legislators that politicians should stop trying to practice medicine and stop trying to play doctor."